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Budget impact analyse Neuro-HIFU ter behandeling van essentiële tremor

Nuijsink, Corine (2021) Budget impact analyse Neuro-HIFU ter behandeling van essentiële tremor.

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Abstract:Introduction: Essential tremor (ET) is the most common movement disorder, in which patients experience involuntary, rhythmic and sinusoidal alternating movements. ET occurs mainly in people over 60 years of age. A patient with tremor symptoms is usually the first to report to the general practitioner . They may prescribe Propranolol to reduce the symptoms. If this does not provide enough effect, the patient is referred to a neurologist. In addition to propranolol, he may also prescribe Primidone, topiramate, alprazolam or gabapentin. However, about 50% of patients do not respond to these drugs, they are called medication refractory. Within Isala, no surgical intervention is possible for these patients, but a medication refractory ET patient can be referred to a Deep Brain Stimulation- (DBS) or Gamma Knife (GK) center. Given the invasiveness of these treatments, few patients undergo one of these treatments each year. Neuro-HIFU, on the other hand, is a relatively new, innovative incisionless technique. The non-invasive nature of the treatment ensures that most patients experience a reduction in symptoms and an improvement in quality of life immediately after the procedure. Method: In this budget impact analysis (BIA) the expected change in expenditure in the implementation of the Neuro-HIFU treatment compared to the current expenditure on the reference treatment is calculated at hospital level. The reference treatment is 'no active treatment'. This is (currently) the only treatment offered in Isala to medication refractory ET patients. In the intervention scenario, 'no active treatment' is partially replaced by Neuro-HIFU. A time horizon of five years has been chosen. In the scenario analysis, it was decided to use a range in which a minimum and maximum expected replacement of 'no active treatment' by Neuro-HIFU was used. Maximum replacement with Neuro-HIFU leads to an optimistic scenario, in which 75% of patients will opt for Neuro-HIFU in the first year of the time horizon. In a pessimistic scenario, there is a minimal replacement of 'no active treatment' with Neuro-HIFU, in which 25% of patients will opt for Neuro-HIFU treatment in the first year of the time horizon. The number of Neuro-HIFU treatments is expected to increase over the time horizon, due to the increase in popularity. Also, from the second year of the time horizon, reoperations are necessary. In the fifth year of the time horizon, 83% opt for Neuro-HIFU in an optimistic scenario and 33% in a pessimistic scenario. The remaining patients, from both scenarios, continue with 'no active treatment', or opt for DBS or GK. In 2019, the incidence of ET in Isala was 117 patients. The year 2019 is expected to be a representative year for the regular care situation in Isala. Results: Every year 50 patients within Isala are eligible for a surgical procedure. However, only a small proportion opt for one of these treatment options. Because Neuro-HIFU is not invasive, it is expected that relatively more patients will opt for this treatment. In the first year of the time horizon, between 13 and 38 Neuro-HIFU treatments will follow. This number has increased between 18 and 42 patients in the fifth year of the time horizon. The intervention costs in the first year of the time horizon lie between € 599,914.- and € 758,227.- and increase in the fifth year of the time horizon, to an amount between € 625,327.11 and € 783,557.-. The annual costs of the reference treatment are €40,165.-. Conclusion: Due to the introduction of the Neuro-HIFU treatment for medication refractory ET patients in Isala, expenditure will increase in the coming years. The average budget impact over a time horizon of 5 years is between € 572,447.- and € 730,727.-.
Item Type:Essay (Bachelor)
Clients:
Isala, Zwolle, Nederland
Faculty:TNW: Science and Technology
Subject:85 business administration, organizational science
Programme:Health Sciences BSc (56553)
Link to this item:https://purl.utwente.nl/essays/86759
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